1. Association Between Trimethylamine N-oxide and Adverse Kidney Outcomes and Overall Mortality in Type 2 Diabetes Mellitus.
- Author
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Yu PS, Wu PH, Hung WW, Lin MY, Zhen YY, Hung WC, Chang JM, Tsai JR, Chiu YW, Hwang SJ, and Tsai YC
- Subjects
- Humans, Female, Male, Middle Aged, Aged, Biomarkers blood, Creatinine blood, Renal Insufficiency, Chronic mortality, Renal Insufficiency, Chronic blood, Follow-Up Studies, Prognosis, Kidney physiopathology, Methylamines blood, Diabetes Mellitus, Type 2 mortality, Diabetes Mellitus, Type 2 blood, Diabetes Mellitus, Type 2 complications, Diabetic Nephropathies mortality, Diabetic Nephropathies blood, Disease Progression, Kidney Failure, Chronic mortality, Kidney Failure, Chronic blood, Glomerular Filtration Rate
- Abstract
Context: Type 2 diabetes (T2D) is the major contributor to chronic kidney disease and end-stage kidney disease (ESKD). The influence of trimethylamine N-oxide (TMAO) on kidney outcomes in T2D remains unclear., Objective: To examine the association between fasting serum TMAO levels and adverse kidney outcomes in patients with T2D., Methods: Between October 2016 and June 2020, patients with T2D were recruited and monitored every 3 months until December 2021. Serum TMAO levels were assessed using liquid chromatography-mass spectrometry. The primary kidney outcomes were doubling of serum creatinine levels or progression to ESKD necessitating dialysis; the secondary kidney outcome was a rapid 30% decline in estimated glomerular filtration rate within 2 years. All-cause mortality was also evaluated., Results: Among the 440 enrolled patients with T2D, those in the highest serum TMAO tertile (≥0.88 μM) were older, had a longer diabetes duration, elevated blood urea nitrogen, and lower estimated glomerular filtration rate. Over a median follow-up period of 4 years, 26 patients (5.9%) had a doubling of serum creatinine level or progression to ESKD. After propensity score weighting, the patients in the highest serum TMAO tertile had a 6.45-fold increase in the risk of doubling of serum creatinine levels or progression to ESKD and 5.86-fold elevated risk of rapid decline in kidney function compared with those in the lowest tertile. Additionally, the stepwise increase in serum TMAO was associated with all-cause mortality., Conclusion: Patients with T2D with elevated circulating TMAO levels are at higher risk of doubling serum creatinine, progressing to ESKD, and mortality. TMAO is a potential biomarker for kidney function progression and mortality in patients with T2D., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)
- Published
- 2024
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